Decreasing the Use of Mechanical Restraints and Locked Seclusion

Abstract

This article describes attempts by an inpatient unit, treating adolescents with developmental delays and with severe psychiatric disturbances, to reduce its use of physical restraints. This restraint reduction process involved two phases: (1) assessment and (2) systems intervention. The assessment phase consisted of extensive observations of staff response to patient crises, staff interviews, patient interviews, and the development of a data-tracking system for restraint and seclusion (R/S) usage. Multiple contributing factors were identified during the assessment phase that increased R/S usage. The second phase, organizational and clinical intervention, included staff education and training, treatment interventions, and system changes aimed at reducing R/S usage. R/S reduction data over the course of the project are presented.

Evaluation of service users' experiences of participating in an exercise programme at the Western Australian State Forensic Mental Health Services

“…The development of trusting and respectful interactions between patients and staff as a result of engaging in such activities is a valuable asset for decreasing the use restraint and seclusion, and in promoting harmony and collaboration in secure inpatient settings (Schreiner et al 2004). Circuit cricket was the most popular game identified by participants, and this team sport also demonstrates how meaningful activities can bring together people from diverse cultural backgrounds and language groups to enjoy physical activity.…”

Decreasing the Use of Restraint and Seclusion Among Psychiatric Inpatients

“…17,[22][23][24] Rates of restraint and seclusion may be affected by differences in hospital characteristics independent of patient population, 25 including geographical location, 25,26 size, 15 and patient-to-staff ratio. 27 Several authors have described efforts to reduce rates of restraint and seclusion, 10,16,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] mostly in urban psychiatric hospitals, in adult 10,[28][29][30][31][32][33][39][40][41][42] or adolescent [34][35][36][37][38] units, or in psychiatric emergency departments. 33 One common component of such programs is improved staff education that includes addressing opinions and beliefs about use of restraint and seclusion, providing information about regulations and hospital policies, and suggesting alternative methods for de-escalating patient behaviors.…”

“…33 One common component of such programs is improved staff education that includes addressing opinions and beliefs about use of restraint and seclusion, providing information about regulations and hospital policies, and suggesting alternative methods for de-escalating patient behaviors. [28][29][30]35,36,39,41 In a study at one hospital, Klinge demonstrated that staff had a range of opinions regarding indications for restraint and seclusion, 43 which suggests that staff education could improve uniformity of beliefs and clinical practice. Debriefing of staff after events 34,39 can be both an educational opportunity and a way for hospital leaders to learn more about the context and frequency of restraint and seclusion use.…”

“…Debriefing of staff after events 34,39 can be both an educational opportunity and a way for hospital leaders to learn more about the context and frequency of restraint and seclusion use. Other interventions include monitoring and evaluation of all episodes of restraint and seclusion 29,31,32,35 identifying patients who are at high risk for restraint or seclusion, employing behavioral interventions with those individuals. 29,32,33 and using pulse oximetry during restraint episodes to decrease the risk of asphyxia.…”

“…27 Many studies cite the importance of a culture change 42 in which hospital leaders emphasize the importance of reducing use of restraint and seclusion. 10,30,35,36 The New York State Psychiatric Institute (NYSPI) is a facility that provides acute inpatient care for both clinical and research populations, including many individuals with serious and persistent mental illnesses. In the year 2000, NYSPI initiated an institute-wide program to reduce rates of restraint and seclusion.…”